The purpose of the study was to determine the age at which young asthmatic children could master the use of a new powder inhaler device (Turbuhaler). We studied 59 children with asthma between the ages of 3 and 6 years who consecutively attended the asthma clinic of the pediatric department. Efficiency of inhalation and the pharmacological effect of the terbutaline in the inhaler were measured by scores for inhalation technique and clinical response. None of the 3-year-old children used the device efficiently, but 43% of the 4-year-old, 67% of the 5-year-old, and 80% of the 6-year-old children used the inhaler correctly. Although inhaler technique was not perfect in the younger age group, 50% of the 3-year-old children demonstrated clinical improvement of asthma symptoms after inhalation. In the older age groups, 79%, 92%, and 100% of the 4, 5, and 6-year-old children demonstrated clinical improvement of asthma symptoms after inhalation. It is concluded that the new mode of dry powder delivery system (Bricanyl Turbuhaler) can be used in young asthmatic children who are 4 years of age and above.

Thirty-seven children and adolescents on renal replacement therapy (11 on haemodialysis, 14 on continuous ambulatory peritoneal dialysis and 12 after renal transplantation) were studied by echocardiography, echo-Doppler and phonocardiography. Right and left ventricular (R/L V) diastolic functions were measured by transmitral and transtricuspid flow velocities and by LV isovolumic relaxation time (LVIRT). Thirty-seven age- and sex-matched healthy subjects served as controls. R/L V diastolic dysfunction was only observed in the dialysis patients. In these patients LVIRT was prolonged. LV and RV peak inflow velocities were increased both in early (E) and late (A) diastole with a reduction in the E/A ratios. This pattern of diastolic dysfunction is compatible with the combined effects of a hypercirculatory state (volume overload, anaemia, arteriovenous fistula) and an abnormality of cardiac relaxation. The transplant patients showed no major cardiac abnormalities.

Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.